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There are 2 days left in 2017 and I've considered writing this blog post for most of the previous 363. It's on a topic that nobody wants to talk about. Ever.

Let me start by saying Crohn's disease is a stigmatized disease. A recent study found it's more stigmatized than HIV/AIDS and genital herpes among the general public. And this topic, I think, takes that stigma and multiplies it by about 8.

Most people who know anything about IBD know it involves a few main issues: diarrhea, abdominal pain, and sometimes blood in said diarrhea. Because Crohn's is a giving disease, it also comes with a slew of other problems including joint pains, eye inflammation, skin inflammation, bone density loss, mind-numbing fatigue, and fuzzy toenails.

Ok maybe not that last one.

Around 1/3 of us develop "fistulizing disease." Or what I like to call body termites. Fistulas aren't unique to IBD and can happen for other reasons, but IBD is a main source of the fistula…

Let me tell you about the IBD personality. The antiquated and debunked theory that, due to certain personality structures or tendencies, a person will develop a destructive disease of the digestive system.

Surely we must go WAY back in the medical literature to find people who write about this!

I first learned about the IBD personality during my dissertation. My project was the first study evaluating disease-related stigmatization in IBD patients. You can read the publication here but the entire dissertation is about 150 pages long and who has time for that? Let's just say you have to do a thorough literature review for a dissertation. In that review, I came across research, published research, on the IBD personality.

I was floored. Really, people of the 1940s?I have encountered few calm, phlegmatic persons with this disease. Many of them were emotional, sensitive, rather excitable people. - Dr. Bockus, 1945
Then again, compared to other prevailing medical theories of the …

Ever read something on a medical test result that looked bad? Or, at a minimum, a little suspicious and your doctor either doesn't bring it up or if you ask about it they say "oh that's nothing"? And you're sitting there, kinda confused, kinda concerned. Why do they do that?

Since the creation of the electronic medical record, and patient portals, people have unprecedented access to their medical information. Including reports from tests, from routine blood draws to complicated MRIs, that historically have only been seen by physicians. Unless we specifically requested paper copies. This, combined with Dr. Google, has led to much more educated and informed patients.

*Cue old timey music*

Now kids, pull up a chair. I have a story for yuns....

People my age have one foot in pre-internet times and one in post. I first saw the internet and email in college in 1995 (Netscape Navigator, what?!) I had an AOL account on a dial-up connection. My first cell phone was…

People love to cite them. This is especially true in the context of medical research, You know, so we all can be reminded of our inevitable mortality which will be brought on by some unpleasant disease because we ate too many rice cakes.

I would go so far as to say we have a love-hate relationship with statistics in that people are natural information seekers and simple numbers make it easy to understand complex things. But sometimes the simple numbers are associated with things we don't want to consider, causing a whole lot of cognitive dissonance, so we reject them as spurious tricks some nerd in an ivory tower came up with.

(Don't tell anyone but I'm a nerd in an ivory tower)

I've had this topic on my "what should I write about" list for a while, and a tweet by a member of my IBD tribe (Are people over the age of 40 allowed to use the word "Tribe"?) prompted me to sit down and write a, hopefully, clear how-to-read-common-statistics…

dis·or·der disˈôrdər/ adisturbanceinphysicalormentalhealthorfunctions;maladyor dysfunction
I was in New York this weekend for the annual meeting of the American Neurogastroenterology and Motility Society, a gathering of experts in the field of functional digestive illness. This year had a heavy psychology presence, which was pretty exciting since psychology was integrated into most sets of talks on a certain topic or condition. Because, you know, psych is important.

On Saturday, Dr. Sarah Kinsinger, now director of the adult GI behavioral medicine program at Loyola University outside of Chicago, spoke on the topic of eating disorders. Sarah and I worked together at Northwestern for about a decade before she moved on to start the Loyola program. We talked a bit the day before about her presentation and she expressed some concerns about the potential for controversy due to the highly sensitive nature of the topic.

If you live with a chronic illness that makes you feel nauseous 23 hour…

Recently I ran a very scientific Twitter poll and asked people about how they'd feel if they found out their therapist had the same/a similar chronic disease as they did, if the disease was the reason the person was seeking counseling.

Here are the results:

Most people, 42 out of 49, would be thrilled to indifferent about the news. However, 13% (or 7) would feel some concern or even switch therapists. Since this is a very small sample of people, we shouldn't disregard that some people don't find this appealing.
I was diagnosed with Crohn's in 2002 and at that time was living a completely different life. I worked in a corporate job writing code for .NET applications for a commercial real estate company. Exciting stuff, I know. I was making a good wage, had health insurance (!!), and a clear career path laid out at 26. I was also working on a huge project for Microsoft, as a client of the company I worked for, that I knew was going to fail. We're talking 80+ h…

Ever walk out of a medical visit questioning your own reality? Like, what the hell just happened? I am having symptoms, right? They are serious, right? I wouldn't show up to see a doctor if I wasn't actually in distress, right?

The term "gaslighting" has been around for a long time, gaining in popularity in recent years, as a way to describe a strategy of psychological manipulation to make someone question their own perceptions of reality. The term comes from a 1930s play Gas Light where a husband goes to great lengths to convince his wife she's insane and her only tangible symbol of reality becomes the nightly dimming of the gas lights in their home.

Gaslighting is a malicious act. I don't portend in the slightest that 99.9% of medical professionals intentionally gaslight their patients. However, there are definitely qualities of our exchanges with the medical system that can leave us feeling, well, insane.

Well hey there boys and girls! Long time, no blog. I could get into the reasons why I fell off the wagon, but there are many and it'd be a long, drawn out story that isn't very interesting. So instead of rehashing the past, I'd like to jump right into this post on a dry but critical topic.

Health insurance.

In the news a lot the past few months, isn't it? That's not why I'm here. I'm here for more pressing things like CPT codes.

I've been to a couple of conferences in the past few weeks and this has come up more than once, from both my physician peers and patient advocates:

Will insurance cover visits to a mental health clinician for issues dealing with a chronic medical illness?

In case you missed it, I'm a licensed clinical psychologist. One of several types of clinicians qualified to do psychotherapy. I hold a doctorate in clinical psychology (PsyD) which means I did 5 years of graduate…